Sunday, November 16, 2008


"The Baucus plan would seek a continued focus on the high value of primary care-related services, with corresponding reductions in relative values for overvalued services."

"To avoid cost inflation, this proposal should be made budget-neutral. Budget-neutral changes to Medicare payments mean that any increase to primary care providers requires a corresponding cut to specialist services. This approach has the potential to create significant controversy among physicians, however. Any reforms along these lines must be crafted in collaboration with the entire physician community and other practitioners to ensure appropriate valuation of, and access to, primary care services."
- White paper from the Chairman of the Senate Finance Committee, Senator Max Baucus (D. Mont)

Any appreciation for one's skill level and years of experience: overvalued.

Requiring five additional years of subspeciality training: overvalued.

Being paid well below what generalists were making during those five additional years of training: overvalued.

Requiring two more recertifications every 10 years and the expenses incurred for continuing medical education credits to permit sitting for those boards: overvalued.

Performing truly curative procedures, rather than palliating them with medications for a person's lifetime: overvalued.

Being paid the same for a four to five hour case as a two-hour case: overvalued.

Focusing on the already-failed experiments of PQRI and "wellness" and "preventative" initiatives that have bloated our bureaucracy and failed to have any positive return on investment: undervalued, so please, let's do more.

Yeah, I see where this is going...


P.S.: Could someone explain to me why the good Senator's white paper sounded so much like the one from these guys?


Anonymous said...

amen brother. i trained 7 extra years (all clinical) after internal medicine residency. i have 200+k in loans at 8% that compounded interest while training. i lost out on income and 401k's all those years.
now i have a job where i'm on call all the time, which is fine. but yes it embitters me to here that my personal taxes will be increased, my payroll taxes will be increased, and at the same time my revenue will be decreased? dang maybe i can cut back to bankers hours. or if they increase the pay enough, just go practice primary care as i maintain my very expensive in time and $$ board certification in i.m.?

Anonymous said...

These "wellness" and "preventive health" initiatives also have no good science behind them. They are scams and several years ago would have been called quackery. But just look at all of the interests (partners) behind PFCD. There is a lot of money and political power to be made by mandating lifestyle control(!), screening tests and prescriptions for everyone. Primary care is sadly being used as gatekeepers in the proposed managed care under the government's vision for nationalized healthcare. It assumes people are too stupid to know when they need medical care or the care of a specialist and too stupid to eat and live how a bureaucrat thinks is best. If I have a suspicious mole, but have to go through a primary doc to get permission to go to a dermatology specialist, who I would have gone to in the first place if my health was my responsibility, it would have saved money. This isn't about cost containment, this is about making money for those partners above. If I ever have a heart problem, I would want to go right to Dr. Wes, not have some primary doc who isn't a specialist in cardiology try to manage my care. As a consumer, I resent having to go to a gatekeeper primary care doctor or having them "manage" my health for me.

Anonymous said...


Your attempts to equate the length of training to income do not necessarily make sense. Otherwise we would have alot of very well off philosophy professors and we would not have these inflated salaries of hospital administrators that you have noted.

Secondly, there are many (though dwindling ) numbers of rheumatologists, endocrinologists, physiatrists, etc., who have put additional years of training in with little increase in their compensation. And what about the difficulty of the residency program? I remember radiology residents yelling at me for getting them up at 2 AM to look at a film that was taken 3 hours earlier, that I couldn't get to because we were trying to stabilize a patient on the floor!

There are clearly disparities in pay accross medical fields that need to be properly adjusted and not just for primary care.

I would also suggest to you that the growth of technology has resulted in many new procedures that get lumped into the overall pool of funds that resulting in shifted payments away from cognitive care fields and to procedurally oriented fields since. I have yet to develop a new method of seeing patients that will get me a higher level of reimbursement, or something siple to stick into them, we end up with the reccurent threat of reimbursement decreases. Meanwhile, over the years we have seen the creation of every scanning technique known to man, stenting of vessels (which may have questionable efficacy) and gobs of new devices and orthopedic procedures that drain funds away from us medical dinosaurs. This is in no way a fair and equitable system and will eventually lead to the demise of health care as we know it if we do not rein in these expenses.

Specialist have seen there incomes soar under the current system and it seems to me like it is time to redistribute the pie that your comrades have been consuming the biggest piece of for some time.

Lastly, worth of a profession has to be comensurate with its value it produces, and it does not matter whether someone spends 7 years learning procedures that do little to improve patients health and well being. So specialists cannot expect to put in a few extra years (especially if you take all education from undergraduate on) and make 3-5 times what a primary care doc makes. If time in education was proprotional under this senario, then specialist would make one third more than say a pediatrician or internist, which would seem fine to me. Increase compensation for stress of the job (more for interventionalist vs those radiologists) and for on call and after hours work. Whats wrong with that?